What is the Current Public Health Situation in Kashgar Rural Areas?

By Jiaxin Cai, Haonan Gong, Hanfei Cao, Runjia Tian, Xunrui Zhang

“Every household in the village has land to grow grapes and pomegranates. As long as they have enough labor force to plant and sell, they will not be poor. But some families are poor because of illness. The lack of labor will always result in low economic income.” Said a staff member at the Shenzhen Counterpart Support Xinjiang(Kashgar) Social Work Station.

A nine-year-old child with cerebral palsy (middle) in a village of Boshikeranmuxiang, whose medical costs take up half of his family’s income

Due to some historical reasons, the medical and health conditions in Xinjiang, especially in the Kashgar region, were not competent for a long time.

In 1990, the mortality rate in Kashgar was 9.38%, higher than the 6.28% in the whole country [1]. The relatively high mortality rate was partly due to a lack of basic medical facilities and skills. Until 2011, nearly 94%[2] of public health workers in rural areas of Kashgar did not achieve the degree of specialized secondary school. Hence, in the past, “inaccessible and expensive medical treatments” was the main problem for poor people in this area.

With the implementation of the poverty alleviation policy and the aid programs in Xinjiang, the medical and health situation in Xinjiang has greatly improved in recent years.

Due to aid programs from many other places, major hospitals in Kashgar have gradually improved their hardware equipment and medical skills. The only two regional hospitals in Kashgar received assistance from metro cities: the Kashgar First People’s Hospital was jointly assisted by Beijing, Guangzhou, and Zhongshan, while the Kashgar Second People’s Hospital was assisted by Shanghai.

Even though much progress has been made, medical and health care in Kashgar, especially in rural areas, still faces challenges. Villages in Boshikeranmuxiang are typical examples.

The township, which is famous for its favorable condition for the fruit and forestry industry, is about a 40-minute drive from downtown Kashgar. It is divided into 20 villages, with a total population of 47,248, mainly Uighurs.

Despite the favorable natural conditions, there used to have many needy families. The reasons for their existence and the emergence of some extreme cases of low-income families today are all highly related to the local medical and health conditions.

Medical treatments and public health issues in Kashgar rural area, Boshikeranmuxiang


“Hypertension, hyperglycemia, hyperlipidemia, tuberculosis, and coronary heart disease are main problems here,” a medical worker from one village clinic in Boshikeranmuxiang said.

In this village of 2568 people, 15 people are diagnosed with Type 2 diabetes mellitus, and 115 people are diagnosed with hypertension.

The local diet has a high correlation with these chronic diseases. In general, the local diet is relatively simple. Most local families have high carbohydrates, high salt meals, with little vegetables.

Gangzirou is a common food in Kashgar’s rural areas

“Most locals only eat Nang, a kind of crusty pancake, and drink tea for breakfast. Sometimes they even skip breakfast. For dinner, they always eat a large number of carbohydrates and meats” volunteers in the Shenzhen Counterpart Support Xinjiang(Kashgar) Social Work station said.

This dietary structure has led to diseases such as diabetes in long term, and severe diabetes could cause loss of household labor.

“My father used to be a little plump. After he got diabetes, he became very thin. Now it is hard for him to gain weight and do heavy work,” said Mi, a college student in the village. Her father preferred salty pasta for years. When he was diagnosed with diabetes, the family’s living expenses and school fees cause a burden on Mi’s brother.

Another common disease is tuberculosis, which is caused by germs. Symptoms are cough and hemoptysis. Its incidence is mainly related to local hygienic practices.

“In the past, the old generation doted on their grandchildren and gave their grandchildren the food they had eaten. As a result, germs spread along with love,” said a female doctor at the village health station. In addition, spitting and exchanging teacups can also cause transmission.

Tuberculosis was severe in the village before, with the highest record of up to 28 people.

Another disease, which is closely related to hygienic practice, is gynecological disease. Lack of habit to frequently change clothes and take a bath consciousness induced numerous gynecological diseases, such as pelvic inflammatory disease. Coupled with conservative thinking in rural areas, some patients are reluctant to see a doctor, and their conditions gradually worsens.

“It was really difficult to take a bath in the countryside before. Also, women were ashamed to talk about these diseases and reluctant to go to the hospital in time. In some cases, these practices also cause cancer,” said a social worker who has worked there for more than a decade.

Cerebral palsy, a disease caused by non-progressive brain injury in infants or young children, mainly manifested as motor impairment, low intelligence, is also one of the most common sicknesses in the village. The causes of cerebral palsy were related to the lack of knowledge during pregnancy.

“My child was born at home without crying. He was found to have cerebral palsy when taken to hospital for tests,” a mother in Boshikeranmuxiang explained her 19-year-old daughter’s illness. At the time of the birth, the mother’s family members were not at home, forcing her to choose to give birth at home because of the inconvenience of transportation.

The house of a nine-year-old child with cerebral palsy

Another grandmother of a nine-year-old child with cerebral palsy said, “I can’t go out to work since I need to take care of my grandchildren. I take him to the hospital every day, and the cost of transportation and meals adds up to about 100 yuan per day.” The daily treatment cost is a burden on the family, which only has a 30,000-yuan annual income.

What these health problems can reveal is that there are still many limitations in local medical and health conditions, such as the shortage of medical experts and technology.

The medical staff explained that there were only five doctors in the whole village. Although there are more doctors than there were a few years ago, it is still not enough.

A more serious problem is that the village’s medical support capacity needs to be improved. Most medical workers are unable to treat serious diseases since they have only a nursing background.

When village health stations cannot meet the demand, patients would go to hospitals in towns, Kashgar, and even Urumqi.

A college student in the village said, “whether my father’s brain treatments or my brother’s sore throat treatments, we cannot find effective therapeutic results in hospitals in Kashgar.”

“The doctor in Kashgar told us to go to Urumqi for treatment,” she said. In August, she took her brother to a hospital in Urumqi for treatment: they spent 16 hours on a hard-seat train.

A health station in a village in Boshikeranmuxiang

Efforts to improve the public health in rural Kashgar

In response to the aforementioned situation, unremitting efforts are made to help the Uighurs in rural areas by both the Government and private institutions in terms of medical and health care.

The Kashgar government takes an approach in a macro way, providing a medical security system and building health institutions in towns and villages. 

Medical insurance is one of the most important measures to solve medical and health problems. In October 2019, the Kashgar government implemented the “Triple” medical care policy. Residents could enjoy a certain reimbursement ratio for a specific group of drugs categorized uniformly by China and a group of drugs recognized by the local government since then. The medical care policy covers refund in hospitalization insurance: 70.56 percent refund for residents in Kashgar and 60 percent refund for patients who have a serious disease. 

“The medical costs reimbursement can reach up to 98 percent for extremely poor families,” said the village health station. At hospitals in the Kashgar’s downtown area, “low-income families” (who lose their labor force because their family members are severely disabled or ill and enjoy special allowance) can get reimbursement of up to 65%. In other words, this measure greatly alleviates the problem of “expensive medical treatments”.

Besides the government’s efforts, village health stations take the responsibility of being actual service windows, undertaking the basic medical and health services of the whole village.

Doctors from village health stations will visit each household routinely to check their health conditions, such as blood pressure and blood sugar level. Also, when patients are unable to leave their house, doctors will actively reach out to them and arrange regular follow-up visits. For patients with serious chronic diseases, doctors will check their health conditions every three months. For tuberculosis patients, village health stations also provide nutritious breakfasts to boost their immunity. The actions of the village health stations alleviate the problem of “inaccessible treatments” to a large extent.

The entrance of a village health station in Boshikeranmuxiang

In addition, village health stations help pregnant women establish records at the hospital, have regular birth check-ups, and disseminate information about pregnancy. As a result, some pregnant women are more willing to go to hospitals to give birth than they did before.

Compared to the government, public welfare organizations start with a more specific perspective in offering assistance to vulnerable groups in Kashgar.

Shenzhen Counterpart Support Xinjiang (Kashgar) Social Work Station, established in Kashgar in 2011, is one of the most important non-governmental public welfare organizations in southern Xinjiang. Their work is aimed to strengthen national unity, social stability, rural revitalization, and improve people’s livelihood and social development. Since 2018, they have carried out assistance projects for pregnant women, sick children, and families impoverished by illness.

“Caring for Pregnant Women” is a major medical and health project, which popularizes pregnant knowledge, of the social work station, such as teaching pregnant women to increase their calcium intake at different stages of pregnancy in terms of diet. “93% of women who participated have improved their awareness of birth inspection, active learning, and conception through the project.”

Another project is called “Guardian Angel”, which is about protecting left-behind children. The social work station offers health education to children living in the rural Kashgar area, whose parents went to large cities to work. “We help them develop hygiene habits, including collecting some hygiene supplies for students. The second part is the protection of girls, such as how girls take care of themselves during menstruation,” said the social worker who carried out this project.

Poster about tuberculosis at the village health station in Boshikeranmuxiang

Besides, Shenzhen Counterpart Support Xinjiang(Kashgar) Social Workstation also provides economic assistance to families impoverished by illness to help them better cope with the disease.

The “Donkey Baby” project began in 2019. The social work station attempted to increase the income of those families by sending them a female donkey. So far, the project has donated 52 donkeys to the local area.

An anemic “Donkey Baby” recipient in Boshikeranmuxiang earned 5,000 yuan in six months just by selling donkey milk. With this revenue, she was able to receive treatment at a local private hospital in Boxing. Now, her anemia has been cured.

Nowadays, more and more non-governmental organizations come to Kashgar to help local families face and solve medical and health problems.

In 2021, China House, a social enterprise leading young people to conduct public welfare activities, came to the countryside of Boshikeranmuxiang. It carried out fundraising and donation activities for families impoverished by illness.

In a village in Boshikeranmuxiang, a boy was suffering from throat cancer. Since the family’s annual income was only 7000 yuan, the surgery and therapy were unaffordable for them. Through fund-raising platforms, China House raised 20,000 yuan for the family in one night. Recently, this boy has undergone surgery in Urumqi.

In addition to the government and non-governmental public welfare organizations, some medical enterprises, such as Kashgar Jingeng Luokeman Rehabilitation Hospital, also provides free treatments for cerebral palsy in Kashgar. A nine-year-old boy with cerebral palsy in a village of Boshikeranmuxiang received free treatment in this hospital.

“After taking him to the hospital, we saw hopes. The hospital said that if he can keep being treated before the age of 13, there will be some positive impact on him,” said the child’s grandmother.

Medical records of a nine-year-old child with cerebral palsy at Kashgar Jingeng Luokeman Rehabilitation Hospital

Thanks to the efforts of these organizations, the medical and health situation in Kashgar’s rural areas is constantly improving, and more and more youth devote themselves to the local medical and health construction.

“Today, the medical and health problem in South Xinjiang is not a lack of equipment, but a lack of elite,” said Huan Dong, manager of the Shenzhen Counterpart Support Xinjiang(Kashgar) Social Workstation.

Gu is a high school student in Boshikeranmuxiang. After her grandfather died of tuberculosis and her sister suffered from kidney stones, she suffered from tremendous pains and realized the importance of expert doctors. Therefore, she was determined to become a doctor.

“I plan to study medicine in eastern China and return to work in a hospital in my hometown after graduation,” said Gu, who excelled in school.

As more and more young teenagers like Gu grow up, health care in rural Kashgar may also enter a new era.

Reference:

1.Yang Zheng, Zheng Gang, Zhao Liangquan. Analysis on the mortality and average life expectancy of Uyghur population [J].Northwest Population,1992(03):38-44. (in Chinese)

2. Tao Zhang, Yu Wang, Pengfei Wang, Wei Lin. Investigation and analysis of the current situation of rural medical staff in Kashgar [J]. Chinese medical science,2011,1(22):130-131.

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